While cigarette smoking has declined in prevalence, smokeless tobacco use has consistently increased over the past, decade and an estimated six million Americans use smokeless tobacco daily. The Surgeon General has concluded that the use of smokeless tobacco can cause cancer and oral lesions and can lead to nicotine addiction and dependence. Reduction of smokeless tobacco use, therefore, is a significant public health goal. Two recent studies demonstrated the effectiveness of having dental hygienists provide brief cessation advice and materials to smokeless tobacco users in the context of routine prophylactic oral health care. This study will develop and evaluate two dissemination strategies for encouraging and training dental hygienists to provide ongoing cessation counseling to patients who use smokeless tobacco. One strategy builds on the workshop training of hygienists that was effective in producing practice changes in the investigators' current DENTAL study. The second strategy uses a Self-Study model, a presumably less costly program, where patient and training materials are mailed to target hygienists. Changes in practice behaviors of hygienists in these two interventions will be compared to similarly motivated hygienists in a No-Treatment Control group, who receive self-study training materials at a later date. To increase generalizability, the diffusion will be implemented in communities varying in size in two regions of the United States -- Western Rocky Mountains (6 states) and Mid-Western Plains (5 states). Within each region and community size, three communities similar in relative size, prevalence of smokeless tobacco use, and number of hygienists per capita will be selected and randomly assigned to each of the three conditions. Hygienists and dentists within the targeted communities will be assessed at baseline. Hygienists who complete the baseline assessment and their employer dentists will be mailed recruitment materials to solicit their participation. Post-intervention assessment will be conducted with participants and selected non-participants in the intervention conditions and only with responders in the No-Treatment Control group. Training for hygienists in smokeless tobacco intervention will be comprised of either mailed materials (Self-Study), or a three hour workshop (Personalized Instruction). Hygienist participation in smokeless tobacco training (i.e., requesting self-study materials or attending a workshop), changes in a hygienist's smokeless tobacco counseling practices, and the attitudes of their employer dentists will serve as outcome measures. Hygienist practice changes will be assessed at 3 and 12 months after receiving training. Changes in employer dentist attitudes will be assessed at 12 months following their hygienists' receipt of training. Secondary aims include assessing demographic and professional characteristics associated with participation and response to training, and a cost analysis of the interventions.
| Akers, Laura; Gordon, Judith S; Andrews, Judy A et al. (2006) Cost effectiveness of changing health professionals' behavior: training dental hygienists in brief interventions for smokeless tobacco cessation. Prev Med 43:482-7 |
| Gordon, Judith S; Andrews, Judy A; Lichtenstein, Edward et al. (2005) Disseminating a smokeless tobacco cessation intervention model to dental hygienists: a randomized comparison of personalized instruction and self-study methods. Health Psychol 24:447-55 |
| Gordon, J S; Andrews, J A; Lichtenstein, E et al. (2002) Ophthalmologists' and optometrists' attitudes and behaviours regarding tobacco cessation intervention. Tob Control 11:84-5 |
